Pubdate: Sat, 10 Jun 2000 Source: International Herald-Tribune (France) Copyright: International Herald Tribune 2000 Contact: 181, Avenue Charles de Gaulle, 92521 Neuilly Cedex, France Fax: (33) 1 41 43 93 38 Website: http://www.iht.com/ Page: 3 Author: Marlene Cimons, Los Angeles Times Service HEALTH EXPERTS PUZZLED BY A BRITISH ISLES ILLNESS 59 Cases Among Drug Users Are Stirring Fear WASHINGTON - In a scenario eerily reminiscent of the beginnings of the, AIDS epidemic, nearly five dozen intravenous drug users in Scotland, Ireland and England since April have become ill or died of an unidentified illness. The baffling ailment is characterized by excessive swelling and redness at the injection site, low blood pressure and a high white blood cell count, often followed by heart failure. More than half of the victims have died - most of them about two days after being admitted to a hospital despite treatment with broad-spectrum antibiotics and other measures. While cultures of their blood and tissue have shown multiple organisms, none has yet been identified as the likely culprit. In Glasgow, which has long had the reputation of being Britain's heroin capital, the cases have been largely treated as a drug problem. But the U.S. Centers for Disease Control and Prevention, contacted last month by the British health authorities to help in the investigation, said Thursday in its first public report that "the emergence of a new illness is possible," stressing that it appears to be confined to intravenous drug users. "This is a serious illness among members of this particular community," said Marc Fischer, coordinator of the U.S. agency's surveillance project for unexplained deaths and critical illnesses. "Something is going on, but we're not sure at this point what it is." "The greatest likelihood," Dr. Fischer added, "is that it is an organism previously known and described and showing itself in a new way." He emphasized, however, that because the early part of the illness involves a local reaction at the injection site, "this suggests that it is somehow related to that practice. " The experience of AIDS, which is believed to have begun in Africa, has taught the public health community a sobering lesson that it has not forgotten: Deadly infectious agents are but an airplane ride away. Surveillance has been heightened in Britain and Ireland. In the United States, the Centers for Disease Control sent letters last week to state health authorities alerting them to the cases. Thus far, no U.S. cases have been reported. Health officials are disseminating information about the illness to healthcare practitioners and trying to identify possible risk factors so that prevention strategies can be developed. They are questioning surviving patients to see what they might have in common, specifically sources of their drugs and the timing of their injections. So far 59 cases have been reported 30 in Glasgow, 15 in Dublin and 14 in scattered sites in England, with 30 deaths among them, the Centers for Disease Control said. Health officials at first feared that the cause might be anthrax, because the bacterium had been isolated from the spinal fluid of an intravenous drug user in Oslo who became ill and died. But investigators have found no evidence of anthrax in any of the British cases. Cultures have revealed several different bacteria, however, some of which can cause potentially serious diseases. Because antibiotics failed to help any of the patients, the health authorities speculated that the agent could be a toxin-producing one. Also, the patients typically have a high count of white blood cells, which is often the body's response to an infection or to a toxinproducing agent, Dr. Fischer said. Once a toxin is produced, the illness is difficult to treat unless specific antitoxins are available for the disease. A few toxin-related illnesses, such as botulism and tetanus, can be treated with antitoxins. But, Dr. Fischer said, "We can't treat a toxin when we don't know what it is." - --- MAP posted-by: Derek